Toe–brachial index as a predictor of cardiovascular disease and all-cause mortality in people with type 2 diabetes and microalbuminuria

Abstract

Reduced TBI and ABI were associated with increased risk of CVD and all-cause mortality, independent of traditional risk factors in type 2 diabetes, and improved prognostic accuracy.

Prognostic impact of the ankle–brachial index on the development of micro- and macrovascular complications in individuals with type 2 diabetes: the Rio de Janeiro Type 2 Diabetes Cohort Study

“…As a whole, our findings support the recommendation that the ABI should be more widely used in the routine clinical management of individuals with type 2 diabetes, not only in those with signs or symptoms suggesting PAD, as currently recommended. Some previous longitudinal studies in individuals with type 2 diabetes [20][21][22][23][24][25][26][27][28] and in individuals with and without diabetes [14][15][16][17] have reported that the ABI is a risk marker for future CVE occurrence and mortality, whereas other studies have contradicted this finding [11-13, 18, 19]. Our findings corroborate the studies reporting positive results.…”

“…Of most relevance, few previous studies [24,25,27,28] have addressed whether the ABI is capable of improving risk discrimination beyond a standard risk factor model, which is an important step for recommending the routine use of the ABI in the clinical management of type 2 diabetes. However, the results of these previous studies were contradictory, with two of them showing that the ABI improved risk discrimination [25,28] and the other two failing to demonstrate any improvement [24,27]. The first study [24] evaluated 151 Chinese individuals with type 2 diabetes who were followed for 5 years, with 16 CVEs during follow-up.…”

“…Indeed, some previous studies have demonstrated a lack of prognostic value for the ABI in diabetic individuals in contrast to non-diabetic individuals [11][12][13], although others have reported similar positive predictive performances in diabetic and non-diabetic individuals [14][15][16][17]. Similarly, conflicting results regarding the prognostic value of the ABI have been reported by cohort studies comprised exclusively of individuals with type 2 diabetes, with some studies negating [18,19] and others demonstrating [20][21][22][23][24][25][26][27][28] its importance. Moreover, some of the positive studies [24,25,27,28] assessed whether the ABI, beyond being a risk marker, was also capable of improving risk stratification for adverse outcomes, with contradictory findings.…”

“…Similarly, conflicting results regarding the prognostic value of the ABI have been reported by cohort studies comprised exclusively of individuals with type 2 diabetes, with some studies negating [18,19] and others demonstrating [20][21][22][23][24][25][26][27][28] its importance. Moreover, some of the positive studies [24,25,27,28] assessed whether the ABI, beyond being a risk marker, was also capable of improving risk stratification for adverse outcomes, with contradictory findings. This is a fundamental step before more widespread use of the ABI in the clinical management of type 2 diabetes can be recommended.…”

Transcutaneous oxygen pressure as a predictor for short-term survival in patients with type 2 diabetes and foot ulcers: a comparison with ankle–brachial index and toe blood pressure

“…TBP or ABI were not significantly associated with mortality in our study, which is in contrast to previous results. In a study by Zobel et al [22], a significant association between toe–brachial index (TBI), ABI and mortality was found. Our cohorts differed, however, in baseline criteria as they included patients with type 2 diabetes and microalbuminuria, but no clinical signs of CVD, compared to our unselected high-risk population of DFU patients.…”